Provider Demographics
NPI:1467845115
Name:AUTISM BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:AUTISM BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-678-9497
Mailing Address - Street 1:5750 DRAKE CT
Mailing Address - Street 2:#371
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5750
Mailing Address - Country:US
Mailing Address - Phone:703-678-9497
Mailing Address - Fax:571-312-4642
Practice Address - Street 1:5750 DRAKE CT
Practice Address - Street 2:#371
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5750
Practice Address - Country:US
Practice Address - Phone:703-678-9497
Practice Address - Fax:571-312-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000299103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty